{
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"NamePrefix": null,
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"Credential": null,
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"FirstLineMailingAddress": "11915 ATLANTIC AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RICHMOND HILL",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11418-3216",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "718-805-0700",
"MailingAddressFaxNumber": "718-805-5621",
"FirstLinePracticeLocationAddress": "11915 ATLANTIC AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RICHMOND HILL",
"PracticeLocationAddressStateName": "NY",
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"PracticeLocationAddressTelephoneNumber": "718-805-0700",
"PracticeLocationAddressFaxNumber": "718-805-5621",
"EnumerationDate": "09/08/2014",
"LastUpdateDate": "09/08/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LOPEZ",
"AuthorizedOfficialFirstName": "YVONNE",
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"AuthorizedOfficialTitle": "CREDENTIALING MANAGER",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "718-805-0700",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Optometrist",
"LicenseNumber": "TUV008183-1",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}